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PubMed2003

Prevalence of enterotoxigenic Escherichia coli (ETEC) in hospitalized acute diarrhea patients in Denpasar, Bali, Indonesia.

The relationship between enterotoxigenic Escherichia coli (ETEC) and hospitalized patients with acute diarrhea was examined in a study conducted in two hospitals from June 2000 to May 2001 in Denpasar, Bali, Indonesia. A total of 489 hospitalized patients with acute diarrhea were enrolled, and their rectal swabs were screened for enteric bacterial pathogens. Toxins, colonization factor antigens (CFAs), in vitro antimicrobial susceptibility and seasonal distribution patterns associated with ETEC were ascertained. The diagnosis of ETEC infection and CFAs association were performed with GM-1 ELISA and Dot blot immunoassays. Enterotoxigenic Escherichia coli was isolated from the rectal swabs of 14.9% of the patients. The distribution of toxins among the ETEC strains found was ST in 51 (69.9%), while LT and ST/LT were found in 28.8% and 1.3% respectively. The highest isolation rate for ETEC was found among children between the ages of 1 and 15 years. Colonization factor antigens were identified in 28.8% of the ETEC strains. A high prevalence of CFA was found among the rectal swabs of patients with ST isolates. High frequency of resistance to ampicillin, trimethoprim/sulfamethoxazole, chloramphenicol, tetracycline and cephalothin was displayed among the ETEC strains. All ETEC strains were susceptible to norfloxacin, ciprofloxacin and nalidixic acid. The results of this study document the prevalence of ETEC in hospitalized patients with acute diarrhea in Denpasar, Bali, Indonesia. Data generated in this study depicts the prevalence of ETEC diarrhea and CFA types among diarrhea patients in the tourist city of Denpasar, Bali, Indonesia.

Acute Disease↗
PubMed1988

Occurrence of H-antigen Z66 of R phase in cultures of Salmonella serovar typhi originated from Indonesia.

Eighteen strains of Salmonella choleraesuis subsp. choleraesuis serovar Typhi (S. typhi) isolated from blood of patients in Japan who had visited Indonesia and returned before the onset of typhoid fever were found to possess the H-antigen Z66 reported by Guinée et al. (1981) but had the naturally occurring H-antigen d. They were not lysed by any of the phages of the Vi phage typing system. After passage through semi-solid medium containing H-Z66 antiserum, H-antigens of 11 of 18 cultures with H-Z66 phage changed to H-j and those of 2 others to H-d, while the remaining 5 were immobilized. With cultures in the H-d or H-j phages, change of the H-antigens did not occur when they were cultured in semi-solid medium containing homologous H-antiserum. These phase induction experiments as well as colony examination of original cultures suggest that H-Z66 phase is unstable and tends to change to the H-j phase. It also suggest that the original H-Z66 cultures in which change of H-antigen to H-d or H-j occurred without difficulty probably represented a mixed population of cells in the H-Z66 and H-d or H-j phases. Since none of 856 isolates from Japan or from imported cases of typhoid fever from Southeast Asia other than Indonesia exhibited the H-Z66 antigen, it was concluded that the focus of typhoid fever caused by S. typhi in H-Z66 phase was probably in Indonesia.

Antigens, Bacterial↗
PubMed1998

Pediatric cardiac surgery in Indonesia.

Pediatric cardiac surgery in Indonesia first developed thanks to the cooperation of various cardiac centers abroad. The establishment of the 'Harapan Kita' National Cardiac Center in 1985 was one of the most important initial steps. Thereafter, the discipline advanced remarkably in terms of the number of the operations performed and the variety of the diseases treated and, as a result, the surgical outcome also improved. Numerous problems remain to be solved. Only 1% of the children with congenital heart disease are today properly treated in Indonesia. Some of the underlying problems responsible for this situation include a shortage of pediatric cardiac professionals, the lack of the information and education on the part of the patients, and a shortage of funding, both privately and publicly. It would thus be welcome for pediatric cardiac surgeons, cardiologists and nurses in Indonesia to learn about congenital heart disease from doctors and nurses in advanced countries in order to improve the outlook at home.

Child↗
PubMedDate not supplied

Terrorism in Indonesia.

Indonesia has had its share of natural and manmade disasters. From 1997 to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks. In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total of 224 persons have been killed, and 340 persons have been injured. Most of those killed or injured were the result of the bombings in Jakarta and Bali. Besides bombings, there have been riots, especially in Jakarta. The Indonesian Surgeons Association established the 1-1-8 Emergency Ambulance Service Foundation to develop the Prehospital Emergency Medical Services in Indonesia. Despite difficulties, this service has been implemented in 18 cities. The occurrence of disasters, riots, ethnic conflicts, terrorist attacks, and the introduction of the Advanced Trauma Life Support (ATLS) course in 1995, have helped to convince the people and the government that it was important to develop this 1-1-8 Emergency Ambulance Services system, and agreed to accept a Safe Community Program. With the Safe Community Program, Jakarta with its Integrated 1-1-8 Emergency Ambulance Service managed to provide proper emergency medical care to the casualties caused by terrorist bombings, riots, and in the three weeks of floods during which 75% of Jakarta was submerged.

Civil Defense↗
PubMedDate not supplied

Complex emergencies in Indonesia.

Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.

Civil Disorders↗
PubMed2007

Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia.

OBJECTIVE: Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures. DESIGN: Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < - 2), underweight (weight-for-age Z-score < - 2) and stunting (height-for-age Z-score < - 2), and severe wasting, underweight and stunting (defined by respective Z-scores < - 3). SETTING: In total, 175,583 households from urban slum areas in Indonesia. SUBJECTS: Children 0-59 months of age. RESULTS: The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08-1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03-1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04-1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker. CONCLUSIONS: Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.

Adult↗
PubMed2004

Home deliveries in Indonesia: who provides assistance?

Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.

Adult↗
PubMed2002

The amount of carbon released from peat and forest fires in Indonesia during 1997.

Tropical peatlands are one of the largest near-surface reserves of terrestrial organic carbon, and hence their stability has important implications for climate change. In their natural state, lowland tropical peatlands support a luxuriant growth of peat swamp forest overlying peat deposits up to 20 metres thick. Persistent environmental change-in particular, drainage and forest clearing-threatens their stability, and makes them susceptible to fire. This was demonstrated by the occurrence of widespread fires throughout the forested peatlands of Indonesia during the 1997 El Niño event. Here, using satellite images of a 2.5 million hectare study area in Central Kalimantan, Borneo, from before and after the 1997 fires, we calculate that 32% (0.79 Mha) of the area had burned, of which peatland accounted for 91.5% (0.73 Mha). Using ground measurements of the burn depth of peat, we estimate that 0.19-0.23 gigatonnes (Gt) of carbon were released to the atmosphere through peat combustion, with a further 0.05 Gt released from burning of the overlying vegetation. Extrapolating these estimates to Indonesia as a whole, we estimate that between 0.81 and 2.57 Gt of carbon were released to the atmosphere in 1997 as a result of burning peat and vegetation in Indonesia. This is equivalent to 13-40% of the mean annual global carbon emissions from fossil fuels, and contributed greatly to the largest annual increase in atmospheric CO(2) concentration detected since records began in 1957 (ref. 1).

Atmosphere↗
PubMed2003

The impact of the 1997-98 East Asian economic crisis on health and health care in Indonesia.

This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.

Economics↗
PubMed2003

Plasmid-mediated resistance of Neisseria gonorrhoeae strains isolated from female sex workers in North Sumatra, Indonesia, 1996.

BACKGROUND: Sentinel surveillance of the antimicrobial resistance of strains isolated from female sex workers in North Sumatra, Indonesia, has been carried out since 1975. In 1996 a high prevalence of strains with plasmid-mediated resistance to tetracycline and penicillin was observed. GOAL: The goal was to further characterize strains isolated from a core group of patients in Indonesia with sexually transmitted infections in 1996. STUDY DESIGN: The strains were characterized by antimicrobial susceptibility testing, plasmid analysis, subtype of the determinant, and analysis of genomic DNA by pulsed-field gel electrophoresis (PFGE). RESULTS: A total 161 strains obtained from 592 female sex workers in 10 different places in North Sumatra, Indonesia, in 1996 were investigated. All strains exhibited plasmid-mediated resistance to penicillin (PPNG: penicillinase-producing ) and/or tetracycline (TRNG: tetracycline-resistant ); 115 strains were PPNG/TRNG (71%), 45 were TRNG (28%), and 1 was PPNG. All strains were susceptible to ceftriaxone, ciprofloxacin, kanamycin, and spectinomycin. All PPNG strains tested carried the 7.2-kb (Asian type) plasmid except one, which carried the 4.9-kb (Toronto type) plasmid. All TRNG strains except one contained the Dutch-type gene. PFGE analysis of 156 strains documented that a diversity of strains existed and that certain genotypes had spread in a defined area or between different areas in North Sumatra. CONCLUSION: Our results underline the importance of continuous surveillance of the changing patterns of antimicrobial resistance of in high-risk populations.

Anti-Bacterial Agents↗
PubMed1997

Genetic, antigenic and serologic characterization of human immunodeficiency virus type 1 from Indonesia.

To examine the genetic and antigenic characteristics of HIV-1 in Indonesia, samples from 19 HIV-positive volunteers were studied. By a combination of PCR typing and DNA sequence analysis, 12 of the 19 volunteers were determined to be infected with HIV-1 clade B and seven with clade E. Six of the seven Indonesian clade E isolates were from volunteers associated with the Indonesian Military during a peacekeeping mission in Cambodia. Infectivity reduction neutralization assays showed that the Indonesian E viruses were effectively neutralized by Thailand clade E HIV-1 antisera but not by U.S. clade B antisera. The Indonesian clade B virus tested was neutralized by U.S. clade B antisera and not by the Thailand E antisera. Using a previously described serologic typing ELISA based on clade B and E V3 peptides, genetic clade was accurately determined in eight of eight sera tested. This is the first report of the genetic and antigenic analysis of HIV-1 isolates from Indonesia. The data indicate that at least two genetic and antigenic HIV-1 clades (clade E and B) circulate in Indonesia.

Amino Acid Sequence↗
PubMed2006

Fluoroquinolone-resistant Neisseria gonorrhoeae in Bali, Indonesia: 2004.

OBJECTIVES: In the mid-1990s, fluoroquinolones were introduced in Indonesia for the management of gonorrhea and are now part of the national recommended treatment guidelines. We recently documented introduction of ciprofloxacin-resistant Neisseria gonorrhoeae strains in female sex workers (FSWs) in Timika, Indonesia, 5 years after treating gonococcal cervicitis with ciprofloxacin and periodically monitoring antimicrobial susceptibility of isolates. To assess the importance of this observation, we determined antimicrobial susceptibilities and strain types of N. gonorrhoeae isolates from FSWs seen in a sexually transmitted infection (STI) clinic in Denpasar, Bali, Indonesia. GOAL: The goal of this study was to determine antimicrobial susceptibilities and strain types among N. gonorrhoeae isolated from FSWs in Denpasar, Bali. STUDY DESIGN: FSWs in Denpasar were screened for N. gonorrhoeae by standard culture. Endocervical isolates were frozen in Microbank tubes and sent to the University of California at San Francisco on dry ice. Antimicrobial susceptibility testing using a Clinical Laboratory Standards Institute-recommended agar dilution method was performed at the Centers for Disease Control and Prevention. Isolates were characterized by beta-lactamase production, antimicrobial resistance phenotypes, and auxotype/serovar class. RESULTS: One hundred forty-seven N. gonorrhoeae isolates were characterized. All isolates were highly resistant to tetracycline (minimum inhibitory concentration, >or=16.0 microg/mL): 117 (79.1%) were beta-lactamase-positive (PP-TR), 3 (2.0%) exhibited chromosomally mediated resistance to penicillin (PenR-TRNG), and 27 (18.2%) were susceptible to penicillin (TRNG). All isolates were susceptible to ceftriaxone, cefixime, and spectinomycin; lack of interpretive criteria do not allow interpretation of susceptibilities of cefoxitin, cefpodoxime, or azithromycin. Fifty-nine (40.1%) isolates were ciprofloxacin-resistant; 35 (59.3%) of the ciprofloxacin-resistant isolates exhibited high-level resistance to ciprofloxacin (Cip-HLR; minimum inhibitory concentration, >or=4.0 microg/mL of ciprofloxacin). Three (2.0%) isolates were intermediate to ciprofloxacin. Twenty-two strain types were identified among these isolates; small clusters were identified with 3 strain types. CONCLUSIONS: N. gonorrhoeae isolates from FSWs in Denpasar were resistant to penicillin and tetracycline; 40.1% of the isolates were fluoroquinolone-resistant. With gonorrhea prevalence of 35% at this clinic (by nucleic acid amplified tests), ongoing surveillance for antimicrobial resistance will be needed to appropriately choose treatment for infections caused by these resistant organisms.

Anti-Bacterial Agents↗
PubMedDate not supplied

Molecular epidemiology of hepatitis B virus in Indonesia.

The S-gene sequences of hepatitis B virus (HBV) from 22 carriers in several islands of Indonesia were amplified by polymerase chain reaction, and XbaI-SpeI fragments corresponding to nucleotides 93-529 (437 base pairs) in the S gene were sequenced. The 22 sequences, along with the 5 reported sequences from Indonesia, were compared with each other, and with the corresponding sequences of 20 clones from other countries including China, France, Great Britain, Japan, Kenya, Papua New Guinea, Philippines, USA and USSR. When the 27 HBV DNA clones of various subtypes from Indonesia were classified by the homology in the nucleotide sequence into the five genotypes, twelve belonged to genotype B (subtype adw 7 and ayw 5), 13 to genotype C (adw 1, adr 10, ayr 1 and ar 1), and 2 to genotype D (ayw); none belonged to genotype A or E. Different subtypes of clones in the same genotype indicated that point mutations inducing d-to-y or w-to-r phenotypic changes would be common among Indonesian carriers. Comparison of the translation products of XbaI-SpeI fragments, now available for 47 HBV DNA clones of different genotypes (A 4; B 14; C 21; D 7; E 1), identified several amino acids characteristic to or influenced by the five genotypes as well as those highly conserved by clones of different genotypes.

Amino Acid Sequence↗
PubMed1988

Population movement in Indonesia since 1971.

"This paper attempts to overview and assess developments in the scale, types and impact of population mobility in Indonesia since 1971." Difficulties concerning the availability of data are first considered. "Using qualitative and quantitative information from a range of sources it is evident in this paper that population mobility in Indonesia has a level, scale and complexity that belies the conventional stereotyping of most Indonesians as being highly immobile, scarcely travelling beyond the well-trodden social space of their village and its immediate environs. There are many reasons to explain the increasing population movement; however, there is uncertainty surrounding future patterns of population movement in Indonesia."

Asia↗
PubMed2000

Characterisation of isolates of Haemophilus paragallinarum from Indonesia.

OBJECTIVE: To characterise 18 isolates of Haemophilus paragallinarum isolated from chickens in Indonesia. PROCEDURE: The isolates were identified to species level by traditional phenotypic methods. Six of the isolates were also identified by a species-specific polymerase chain reaction. Fourteen of the isolates were examined for resistance to a panel of seven antimicrobial agents using a disc diffusion method. All 18 isolates were serotyped according to the Page scheme using reference antisera in a haemagglutination inhibition test. RESULTS: Four of the 18 isolates were obtained from indigenous (kampung) chickens, with the remainder being from typical intensive poultry production systems. The 18 isolates were obtained from 11 outbreaks that showed the typical clinical signs of infectious coryza and 11 of the isolates were obtained from chickens that had been vaccinated with infectious coryza vaccines. All 18 isolates were confirmed as H paragallinarum by biochemical testing and six isolates were also identified as H paragallinarum by the polymerase chain reaction test. Eleven isolates were resistant to erythromycin and streptomycin, 10 to neomycin, eight to oxytetracycline, five isolates to doxycycline, three to sulphamethoxazoltrimethoprim but only one to ampicillin. Seven isolates were Page serovar A, four were Page serovar B and seven were Page serovar C. CONCLUSION: The presence of all three Page serovars (A, B and C) has been confirmed for the first time in Indonesian chickens. As the majority of the infectious coryza vaccines in use in Indonesia contain only serovar A and C, the presence of serovar B in chickens indicates that the protection by these bivalent vaccines would be reduced. The use of trivalent infectious coryza vaccines that contain serovars A, B and C is recommended for use in Indonesia.

Animals↗
PubMed1995

International labor migration and the family: some observations from Indonesia.

This article addresses two dimensions of the complex interrelationship between the family and international labor migration in Indonesia: the role of the family in influencing labor movements out of Indonesia; and the consequences of this movement on family well-being, structure, and functioning. Research on this topic in Indonesia is highly limited due mainly to the recency of large scale international labor migration, inadequate data collection systems, a high incidence of undocumented migration, and failure of available research to be sensitive to family related issues. Against a rapidly changing economic and social situation, two major overlapping systems of migration have developed. The official system is focused strongly on the Middle East (although other Asian destinations are increasing in significance) and is dominated by female migrants. The undocumented system is much larger in volume, is focused upon Malaysia, involves more males than females, and is becoming permanent in some cases. The role, status, and experiences of women migrants in relation to their families (decision making, networks, remittances) are discussed with recommendations for other areas needing further research attention.

Asia↗
PubMed2006

Enterobacteriaceae in dehydrated powdered infant formula manufactured in Indonesia and Malaysia.

To determine the occurrence of Salmonella and Shigella in infant formula from Southeast Asia, 74 packages of dehydrated powdered infant follow-on formula (recommended age, > 4 months) from five different manufacturers, four from Indonesia and one from Malaysia, were analyzed. None of the 25-g test portions yielded Salmonella or Shigella. However, further identification of colonies growing on selective media used for Salmonella and Shigella detection revealed the frequent occurrence of several other Enterobacteriaceae species. A total of 35 samples (47%) were positive for Enterobacteriaceae. Ten samples (13.5%) from two Indonesian manufacturers yielded Enterobacter sakazakii. Other Enterobacteriaceae isolated included Pantoea spp. (n = 12), Escherichia hermanii (n = 10), Enterobacter cloacae (n = 8), Klebsiella pneumoniae subsp. pneumoniae (n = 3), Citrobacter spp. (n = 2), Serratia spp. (n = 2), and Escherichia coli (n = 2). To our knowledge, this is the first report to describe the contamination of dehydrated powdered infant formula from Indonesia with E. sakazakii and several other Enterobacteriaceae that could be opportunistic pathogens. Improper preparation and conservation of these products could result in a health risk for infants in Indonesia.

Colony Count, Microbial↗
PubMed1999

Indonesia: an assessment of the health state, health care delivery system, and nursing education.

The purpose of the exploratory, descriptive study was fourfold: 1) to study the nursing education system in Indonesia, 2) to study the health state and health care delivery system, 3) to present various professional issues to nurses, physicians, and other health care professionals, and 4) to develop additional exchange programs between nursing faculty and students of Indonesia and the United States. Baccalaureate education in Indonesia is in the beginning stages of development. The type of hospital is dependent on the number of specialists and options for care. There is a high IMR and MMR, and a high incidence of infectious diseases. Educational exchange programs for faculty and students have been slow to develop.

Delivery of Health Care↗